Endometriosis: The Ultimate Hormonal Disease
Abstract
Estrogen is an extremely potent mitogen for endometrium and endometriosis. Progesterone, on the other hand, inhibits the mitogenic action of estrogen on endometrium and enhances differentiation. These antiproliferative and differentiative effects of progesterone are less pronounced on endometriosis tissue compared with endometrium. Thus, endometriosis is, at least in part, resistant to progesterone action. The product of a single gene named aromatase synthesizes estrogen. The potent estrogen estradiol is metabolized and thus inactivated by an enzyme termed 17β-hydroxysteroid dehydrogenase (HSD) type 2 that is normally induced by progesterone in endometrium. Progesterone action is mediated by its receptor subtypes progesterone receptor (PR)-A and PR-B. We found a number of abnormalities in the expression of aromatase, 17β-HSD type 2, and the PR-B/PR-A ratio in endometriosis tissue. These abnormalities and their functional consequences are discussed in this review article. KEYWORDS Endometriosis - aromatase - aromatase inhibitor - endometrium - estrogen - estrogen biosynthesis - estrogen metabolism - 17β-hydroxysteroid dehydrogenase type 2 - steroidogenesis - progesterone - estrone - estradiol - progesterone receptor
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Endometriosis features estrogen-dependent growth and maintenance of ectopic endometrium and increased local production of estrogens due to molecular aberrations in steroidogenesis.
“Endometriosis has been viewed as a ultimate hormonal disease9, featuring estrogen-dependent growth and maintenance of ectopic endometrium as well as increased local production of estrogens due to molecular aberrations in steroidogenesis10.”
From Platelets induce increased estrogen production through NF-κB and TGF-β1 signaling pathways in endometriotic stromal cells (2020) · cites this paper as [9]
Similarity of molecular biology of TIAR in various tissues with that described in endometriosis strongly suggests that this represents the common underlying mechanisms of both processes.
“The similarity of the molecular biology of TIAR in various tissues with that described in endometriosis [39–41, 59–62] strongly suggests that this represents the common underlying mechanisms of both processes”
From The pathophysiology of endometriosis and adenomyosis, tissue injury and repair (2009) · cites this paper as [59]
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“endometriosis [39–41, 59–62] strongly suggests that this represents the common underlying mechanisms of both processes (Fig.”
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GOSERELIN ACETATE FOR RECURRENT ENDOMETRIOSIS
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Bülbül, M., Nacar, M. C., Türk, B. A., Karaçor, T., Önderci, M., Parlar, A., Kirici, P., & Ucar, C. (2021) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2021.1953453 · Cited by 1 · see citing works
Guo, S. (2011) · Wiley eBooks · doi:10.1002/9781444398519.ch7 · Cited by 1 · see citing works
The 17Beta-Hydroxysteroid Dehydrogenase Type 1 Gene Polymorphism and Endometriosis
Mohammed, M. S., & Kamel, H. (2013) · Journal of Endometriosis and Pelvic Pain Disorders · doi:10.5301/je.5000161
The impact of the herbal formula Qing Bao Zhu Yu Tang in the treatment of endometriosis
Ohm, E., San, Y., & Ryan, L. J. (2014) · International Journal of Herbal Medicine
Molecular Mechanisms Underlying Adolescent Endometriosis and Advancements in Medical Management
Mama, S. T. (2020) · Springer eBooks · doi:10.1007/978-3-030-52984-0_5
Aromataseinhibitoren bei Endometriose?
Ebert, A. D. (2004) · Gynäkologische Endokrinologie · doi:10.1007/s10304-004-0085-2
Khashchenko, K. E. P., Pustynnikova, M. Y., Олегович, К. С., Uvarova, E. V., & Salnikovа, I. A. (2023) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2022-16-23-236-246
Singh, S., Deo, S., Solanki, V., & Nigam, N. (2025) · Annals of African Medicine · doi:10.4103/aam.aam_119_24
“[18] Dysmenorrhea was most common in Stage IV, [8] followed by III, [5] II, [4] and Stage I. [3] Dyparenuia, [4] chronic pelvic pain, [7] menorrhagia, [7] primary infertility, [11] secondary infertility, [2] pain or lump at the former scar site, [2] gastrointestinal symptoms, [9] urinary symptoms,…”
Letrozole plus metformin versus letrozole alone in the treatment of symptomatic endometrioma
Saha, C., Anwary, S. A., Sultana, R., Rolly, S. J., Tarique, M. M. A., Mahmud, S., Salam, S., Rani, R., & Banu, J. (2025) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20252315
Khatun, M. S., Islam, M. A., Islam, T., Islam, M. A., Ishrat, S., Deeba, F., Jahan, N., & Banu, J. (2025) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20252709 · Cited by 1 · see citing works
- Authors
- Gürateş, B., & Bulun, S. E.
- Affiliations
- University of Illinois Chicago (US)
- ORCID
- Serdar Ekrem Bulun
- Venue
- Seminars in Reproductive Medicine
- Publisher
- Georg Thieme Verlag KG
- Published
- 2003
- Volume
- 21
- Issue
- 2
- Pages
- 125-134
- ISSN
- 1526-4564 (ISSN-L)
- 1526-8004
- OpenAlex
- W2413431449
- Cited by
- 94
- References
- 0
- Citations by year
- 2026: 1 · 2025: 5 · 2023: 7 · 2022: 2 · 2021: 4 · 2020: 3 · 2019: 1 · 2018: 1 · 2016: 2 · 2015: 5 · 2014: 2 · 2013: 3 · 2012: 6
- FWCI
- 6.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Seminars in Reproductive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- endometriosis, estrogen, progesterone, aromatase, 17β-hydroxysteroid dehydrogenase type 2, progesterone receptor A, progesterone receptor B, estradiol metabolism, estrone, endometrium, steroidogenesis, aromatase inhibitors
- MeSH terms
- Animals, Aromatase, Drug Resistance, Endometriosis, Enzyme Inhibitors, Estradiol, Estrogens, Female, Hormones, Humans, Isoenzymes, Progesterone, Receptors, Progesterone, 17-Hydroxysteroid Dehydrogenases, Aromatase Inhibitors
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